THE FISCAL YEAR (FY) 2018 Hospital Inpatient Prospective Payment System (IPPS) final rule was released August 3, 2017 and impacted discharges beginning October 1, 2017. This is version 35 of the MS-DRG grouper. The Centers for Medicare and Medicaid Services (CMS) oversees the IPPS and each fis- cal year reviews the current version, takes comments, and implements updates for the next fiscal year, which runs from October 1 to September 30. It is important to note that this article will only cover some of the changes, so be sure to review the complete final rule on the CMS website. The link to the final rule is provided at the end of the article.

Reimbursement Adjustments

The overall average MS-DRG relative weights (RW) increased
0.0036 for F Y 2018. There are 276 MS-DRGs with a RW increase,
while 475 MS-DRG RWs have decreased and three MS-DRG
RWs have stayed the same. MS-DRG 927 (Extensive Burns
or Full-thickness Burns w/ MV>96 hrs w/ skin graft) had the
largest RW increase (approximately + 2.4885) and MS-DRG 215
(Other Heart Assist System Implant) had the largest RW decrease (approximately - 3.2215).

MS-DRG Changes

This is the first year that the MS-DRG review process was basedtotally on claims data containing all ICD-10-CM and ICD-10-PCS codes (using FY 2016 MedPAR files). Now that there aretwo full fiscal years of data available, ICD-9-CM codes are nolonger considered in this process. The MS-DRG changes aretoo numerous to cover completely here, so this article willhighlight some of the changes.

Six procedure codes for insertion of radioactive elements
into the mediastinum or pericardial cavity (0WHC01Z, 0WH-
C31Z, 0WHC41Z, 0WHD01Z, 0WHD31Z, 0WHD41Z) were removed from MS-DRGs 246-249, Percutaneous Cardiovascular
procedures because they are not performed with percutaneous cardiovascular procedures. These six procedure codes are
now assigned to MS-DRG 264 (Other Circulatory System O.R.
Procedures).

Four ICD-10-CM diagnosis codes T49.5X1A, T49.5X2A,
T49.5X3A, and T49.5X4A (Poisoning by ophthalmological
drugs and preparations, initial encounter [accidental, intentional, assault and undetermined intent]) were reassigned
from MS-DRGs 124 and 125 (Other Disorders of the Eye with
and without MCC) to MS-DRGs 917 and 918 (Poisoning and
Toxic Effects of Drugs with and without MCC). This is a more
appropriate MS-DRG for these codes since they are poisonings
and not eye disorders.

In recognition that total ankle replacements (TAR) are
costly to perform, CMS has reassigned the six TAR ICD-10-
PCS codes (0SRF0J9, 0SRF0JA, 0SRF0JZ, 0SRG0J9, 0SRG-
0JA, 0SRG0JZ) from MS-DRG 470 to MS-DRG 469. The title
for MS-DRG 469 was changed to Major Hip and Knee Joint
Replacement or Reattachment of LE w/ MCC or Total Ankle
Replacement.

As a result, all TARs will be assigned to a DRG with an
MCC even if one is not present because these cases require
more resources than other cases assigned to MS-DRG 470